Introduction
Dialectical Behavior Therapy (DBT) is a comprehensive, evidence-based form of cognitive therapy that has become a cornerstone in the treatment of eating disorders. Originally developed by Dr. Marsha Linehan to treat borderline personality disorder (BPD), DBT has proven highly effective for individuals struggling with intense emotions and impulsive behaviors — which are often at the heart of conditions like bulimia nervosa and binge eating disorder. By teaching practical DBT skills in mindfulness, distress tolerance, emotion regulation, and interpersonal effectiveness, dialectical behavior therapy empowers individuals to build a life worth living, free from the grip of their eating disorder. DBT is one of the most well-researched and effective forms of therapy for eating disorders available today.
What Is Dialectical Behavior Therapy (DBT)?
Dialectical behavior therapy is a type of Cognitive Behavioral Therapy (CBT) developed in the late 1980s by Marsha M. Linehan, Ph.D., at the University of Washington. It was originally designed to treat chronically suicidal individuals diagnosed with borderline personality disorder. The term “dialectical” refers to the core principle of balancing acceptance and change — a fundamental tenet of DBT that distinguishes it from other forms of therapy. DBT helps individuals accept themselves as they are while also providing them with the tools to change their harmful behaviors. This DBT treatment approach is particularly effective for mental health conditions characterized by emotional dysregulation, including eating disorders. A comprehensive DBT program typically includes individual therapy, a DBT skills training group, and phone coaching to provide in-the-moment support.
The behavior research and therapy literature on DBT is robust. The efficacy of dialectical behavior therapy has been demonstrated in numerous randomized controlled trials, making it one of the most evidence-based treatments available for complex mental health conditions. The effectiveness of dialectical behavior therapy for eating disorders specifically has been supported by landmark studies, including the work of Safer, Telch, and Agras, who developed a standard DBT adaptation specifically for binge eating disorder and bulimia nervosa.
How Is DBT Used to Treat Eating Disorders?
For many individuals, eating disorder behaviors like restriction, bingeing, and purging serve as a way to cope with overwhelming emotions. DBT directly addresses this underlying emotional dysregulation. A DBT therapist helps the patient understand the function of their behaviors and then teaches them effective DBT skills to use instead. The application of DBT to eating disorders recognizes that these behaviors are not simply about food — they are about patterns of behavior that have developed as a response to emotional pain. DBT focuses on replacing these harmful patterns with healthier, more effective coping strategies.
Research has shown that DBT is particularly effective for eating disorders characterized by impulsive behaviors. For bulimia nervosa, DBT helps individuals manage the intense emotions that trigger the binge-purge cycle, with distress tolerance skills being especially crucial for riding the wave of an urge without acting on it. A landmark study by Safer, Telch, and Agras (2001) found that DBT significantly reduced binge eating episodes in individuals with binge eating disorder. The emotion regulation skills learned in DBT provide alternative ways to cope with the feelings that lead to bingeing. DBT often includes a focus on identifying the specific emotions that trigger eating disorder behaviors, which is a key element of the individual DBT therapy component. DBT includes both acceptance-based and change-based strategies, making it uniquely suited for the complex emotional landscape of eating disorder recovery.
DBT vs. CBT for Eating Disorders
While both DBT and CBT are evidence-based treatments for eating disorders, they differ in important ways. CBT focuses primarily on identifying and changing distorted thoughts and behaviors related to food and body image. DBT, as a modified form of CBT, adds a powerful layer of acceptance-based strategies — including mindfulness and validation — to the change-focused approach. This makes DBT particularly well-suited for patients with high emotional intensity and impulsive behaviors. The right therapy depends on the individual’s specific needs, and many treatment programs, including those at Eating Disorder Solutions, integrate both approaches. The elements of DBT that emphasize acceptance and validation can be especially healing for individuals who have experienced trauma or who struggle with deep shame about their eating disorder.
| DBT Skill Module | Goal | How It Helps with Eating Disorders |
| Mindfulness | Increase awareness of the present moment without judgment. | Helps patients observe binge or purge urges without acting on them; fosters a non-judgmental stance toward food and body image. |
| Distress Tolerance | Survive crisis situations without making them worse. | Provides concrete distress tolerance skills (e.g., self-soothing, distraction) to manage the intense distress that triggers eating disorder behaviors. |
| Emotion Regulation | Understand, label, and manage intense emotions. | Addresses the root cause of many eating disorder behaviors by teaching emotion regulation skills as healthier alternatives to restriction or bingeing. |
| Interpersonal Effectiveness | Build and maintain healthy relationships. | Helps patients communicate their needs, set boundaries, and navigate social situations that may trigger eating disorder urges. |
What to Expect in a DBT Program
A standard DBT program involves several components that work together to provide comprehensive support. Individual therapy sessions with a primary DBT therapist occur weekly and focus on applying DBT skills to specific life challenges and treatment targets. A weekly DBT skills training group is where patients learn DBT and practice the four core skill modules in a supportive environment alongside peers. Phone coaching allows patients to call their therapist between DBT sessions for in-the-moment support on how to use DBT skills during a crisis. A therapist consultation team ensures that DBT therapists are providing effective and adherent treatment. DBT exercises and worksheets are often assigned between sessions to help patients practice DBT skills and apply them in their everyday lives. DBT results are best achieved when all components of the program are engaged with consistently and with commitment.
DBT at Eating Disorder Solutions
At Eating Disorder Solutions, we integrate Dialectical Behavior Therapy into our comprehensive treatment programs across all levels of care. Our expert clinicians are trained in DBT and use its principles to help clients build a foundation for lasting recovery. We offer both individual therapy sessions and DBT skills training groups to ensure our clients receive the full benefit of this evidence-based approach. Our DBT program is designed to help individuals with a range of eating disorders — including anorexia, bulimia, and binge eating disorder — develop the DBT skills they need to manage their emotions and build a life free from disordered eating. Access to DBT is a cornerstone of our clinical model, and we are committed to providing the highest quality DBT treatment available.
Frequently Asked Questions
What are the 4 main skills of DBT?
The four main DBT skills modules are Mindfulness, Distress Tolerance, Emotion Regulation, and Interpersonal Effectiveness. These skills are taught in DBT through a skills group format and are designed to work together to help individuals increase self-awareness, cope with painful emotions, manage emotional responses, and build healthier relationships. DBT skills training is a core component of any comprehensive DBT program and is one of the most important elements of DBT that distinguishes it from other forms of therapy.
Is DBT a type of CBT?
Yes, DBT is a modified form of Cognitive Behavioral Therapy (CBT). While it includes many of the same principles as CBT, dialectical behavior therapy places a greater emphasis on acceptance and mindfulness as a foundation for change. It was specifically designed to treat the severe emotional dysregulation and suicidal behavior associated with borderline personality disorder, and has since been adapted for a wide range of mental health conditions including eating disorders.
Who is DBT not recommended for?
While DBT is a highly effective mental health treatment for many, it may not be the best fit for everyone. Individuals who are not willing to commit to the intensive structure of a comprehensive DBT program — including both individual therapy and group therapy — may struggle to get the full benefit. Additionally, those who are actively psychotic or in need of immediate medical stabilization for their eating disorder would require a different level of care before beginning DBT. A DBT therapist or mental health professional can help determine whether dialectical behavior therapy is the right therapy for a given individual.
What is the 24-hour rule in DBT?
The 24-hour rule in DBT is a guideline that states patients should not call their therapist for phone coaching within 24 hours of a self-harm or suicidal behavior. This rule is designed to prevent the inadvertent reinforcement of harmful behaviors by ensuring that phone coaching is used to help patients use their DBT skills proactively, rather than as a response to a crisis that has already occurred. It is one of the unique structural elements of DBT that supports long-term behavior change.
If you are struggling with an eating disorder and believe that learning new coping skills could help, Dialectical Behavior Therapy may be the right path for you. Contact Eating Disorder Solutions today at 855-245-0961 or visit eatingdisordersolutions.com to learn more about our DBT-informed programs.
